Annals of Surgical Oncology

, Volume 22, Issue 5, pp 1483–1489 | Cite as

Assessing Localized Skin-to-Fat Water in Arms of Women with Breast Cancer Via Tissue Dielectric Constant Measurements in Pre- and Post-surgery Patients

  • Harvey N. MayrovitzEmail author
  • Daniel N. Weingrad
  • Lidice Lopez
Breast Oncology



Skin-to-fat tissue dielectric constant (TDC) values at 300 MHz largely depend on tissue water and provide a rapid way to assess skin water by touching skin with a probe for approximately 10 s. This method has been used to investigate lymphedema features accompanying breast cancer (BC), but relationships between TDC and nodes removed or symptoms is unclear. Our goals were: (1) to compare TDC values in BC patients prior to surgery (group A) and in patients who had BC-related surgery (group B) to determine if TDC of group B were related to nodes removed and reported symptoms and (2) to develop tentative lymphedema-detection thresholds.


Arm volumes and TDC values of at-risk and contralateral forearms and biceps were determined in 103 women awaiting surgery for BC and 104 women who had BC-related surgery 26.3 ± 17.5 months prior to evaluation. Inter-arm ratios (at-risk/contralateral) were determined and patients answered questions about lymphedema-related symptoms.


Inter-arm TDC ratios for group A forearm and biceps were respectively 1.003 ± 0.096 and 1.012 ± 0.143. Group B forearm ratios were significantly greater, and among group B patients who reported at least one symptom there was a significant correlation between TDC ratios and symptom burden and nodes removed.


Inter-arm TDC ratios are significantly related to symptoms and nodes removed. Ratios increase with increasing symptom score and might be used to detect pre-clinical unilateral lymphedema using TDC ratio thresholds of 1.30 for forearm and 1.45 for biceps. Threshold confirmation awaits targeted prospective studies but can serve as guideposts to provide quantitative and easily done tracking assessments during follow-up visits.


Symptom Score Lymphedema Intraclass Correlation Coefficient Tissue Water Manual Lymphatic Drainage 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Conflict of interest

No author has any commercial interest in the subject of this study


  1. 1.
    Alanen E, Lahtinen T, Nuutinen J. Variational formulation of open-ended coaxial line in contact with layered biological medium. IEEE Trans Biomed Eng. 1998;45(10):1241–8.CrossRefPubMedGoogle Scholar
  2. 2.
    Nuutinen J, Ikaheimo R, Lahtinen T. Validation of a new dielectric device to assess changes of tissue water in skin and subcutaneous fat. Physiol Meas. 2004;25(2):447–54.CrossRefPubMedGoogle Scholar
  3. 3.
    Stuchly MA, Athey TW, Stuchly SS, Samaras GM, Taylor G. Dielectric properties of animal tissues in vivo at frequencies 10 MHz–1 GHz. Bioelectromagnetics. 1981;2(2):93–103.CrossRefPubMedGoogle Scholar
  4. 4.
    Mayrovitz HN, Luis M: Spatial variations in forearm skin tissue dielectric constant. Skin Res Technol. 2010;16(4):438–43.CrossRefPubMedGoogle Scholar
  5. 5.
    Mayrovitz HN, Bernal M, Carson S. Gender differences in facial skin dielectric constant measured at 300 MHz. Skin Res Technol. 2012;18:504–10.CrossRefPubMedGoogle Scholar
  6. 6.
    Mayrovitz HN, Bernal M, Brlit F, Desfor R. Biophysical measures of skin tissue water: variations within and among anatomical sites and correlations between measures. Skin Res Technol. 2013;19(1):47–54.Google Scholar
  7. 7.
    Mayrovitz HN, McClymont A, Pandya N. Skin tissue water assessed via tissue dielectric constant measurements in persons with and without diabetes mellitus. Diabetes Technol Ther. 2013;15(1):60–5.CrossRefPubMedGoogle Scholar
  8. 8.
    Mayrovitz HN, Brown-Cross D, Washington Z. Skin tissue water and laser Doppler blood flow during a menstrual cycle. Clin Physiol Funct Imaging. 2007;27(1):54–9.CrossRefPubMedGoogle Scholar
  9. 9.
    Birkballe S, Jensen MR, Noerregaard S, Gottrup F, Karlsmark T. Can tissue dielectric constant measurement aid in differentiating lymphoedema from lipoedema in women with swollen legs? Br J Dermatol. 2014;170(1):96–102.CrossRefPubMedGoogle Scholar
  10. 10.
    Jensen MR, Birkballe S, Nørregaard S, Karlsmark T. Validity and interobserver agreement of lower extremity local tissue water measurements in healthy women using tissue dielectric constant. Clin Physiol Funct Imaging. 2012;32(4):317–22.CrossRefPubMedGoogle Scholar
  11. 11.
    Nixon J, Purcell A, Fleming J, McCann A, Porceddu S. Pilot study of an assessment tool for measuring head and neck lymphoedema. Br J Community Nurs. 2014;19(Sup4):S6–S11.CrossRefGoogle Scholar
  12. 12.
    Mayrovitz HN. Assessing local tissue edema in postmastectomy lymphedema. Lymphology. 2007;40(2):87–94.PubMedGoogle Scholar
  13. 13.
    Mayrovitz HN, Davey S, Shapiro E. Localized tissue water changes accompanying one manual lymphatic drainage (MLD) therapy session assessed by changes in tissue dielectric constant in patients with lower extremity lymphedema. Lymphology. 2008;41(2):87–92.PubMedGoogle Scholar
  14. 14.
    Mayrovitz HN, Davey S. Changes in tissue water and indentation resistance of lymphedematous limbs accompanying low level laser therapy (LLLT) of fibrotic skin. Lymphology. 2011;44(4):168–77.PubMedGoogle Scholar
  15. 15.
    Fife CE, Davey S, Maus EA, Guilliod R, Mayrovitz HN. A randomized controlled trial comparing two types of pneumatic compression for breast cancer-related lymphedema treatment in the home. Support Care Cancer. 2012;20:3279–86.CrossRefPubMedCentralPubMedGoogle Scholar
  16. 16.
    Mayrovitz HN. Local tissue water assessed by measuring forearm skin dielectric constant: dependence on measurement depth, age and body mass index. Skin Res Technol. 2010;16(1):16–22.CrossRefPubMedGoogle Scholar
  17. 17.
    Mayrovitz HN, Weingrad DN, Davey S. Local tissue water in at-risk and contralateral forearms of women with and without breast cancer treatment-related lymphedema. Lymphat Res Biol. 2009;7(3):153–8.CrossRefPubMedGoogle Scholar
  18. 18.
    Aimoto A, Matsumoto T. Noninvasive method for measuring the electrical properties of deep tissues using an open-ended coaxial probe. Med Eng Phys. 1996;18(8):641–6.CrossRefPubMedGoogle Scholar
  19. 19.
    Alanen E, Lahtinen T, Nuutinen J. Penetration of electromagnetic fields of an open-ended coaxial probe between 1 MHz and 1 GHz in dielectric skin measurements. Phys Med Biol. 1999;44(7):N169–76.CrossRefPubMedGoogle Scholar
  20. 20.
    Nuutinen J, Lahtinen T, Turunen M, et al. A dielectric method for measuring early and late reactions in irradiated human skin. Radiother Oncol. 1998;47(3):249–54.CrossRefPubMedGoogle Scholar
  21. 21.
    Casley-Smith JR. Measuring and representing peripheral oedema and its alterations. Lymphology. 1994;27(2):56–70.PubMedGoogle Scholar
  22. 22.
    Mayrovitz HN. Limb volume estimates based on limb elliptical vs. circular cross section models. Lymphology. 2003;36(3):140–3.PubMedGoogle Scholar
  23. 23.
    Karges JR, Mark BE, Stikeleather SJ, Worrell TW. Concurrent validity of upper-extremity volume estimates: comparison of calculated volume derived from girth measurements and water displacement volume. Phys Ther. 2003;83(2):134–45.PubMedGoogle Scholar
  24. 24.
    Mayrovitz HN, Sims N, Macdonald J. Assessment of limb volume by manual and automated methods in patients with limb edema or lymphedema. Adv Skin Wound Care. 2000;13(6):272–6.PubMedGoogle Scholar
  25. 25.
    Meijer RS, Rietman JS, Geertzen JH, Bosmans JC, Dijkstra PU. Validity and intra- and interobserver reliability of an indirect volume measurements in patients with upper extremity lymphedema. Lymphology. 2004;37(3):127–33.PubMedGoogle Scholar
  26. 26.
    Sander AP, Hajer NM, Hemenway K, Miller AC. Upper-extremity volume measurements in women with lymphedema: a comparison of measurements obtained via water displacement with geometrically determined volume. Phys Ther. 2002;82(12):1201–12.PubMedGoogle Scholar
  27. 27.
    Sitzia J. Volume measurement in lymphoedema treatment: examination of formulae. Eur J Cancer Care (Engl). 1995;4(1):11–6.CrossRefGoogle Scholar
  28. 28.
    Armer JM, Radina ME, Porock D, Culbertson SD. Predicting breast cancer-related lymphedema using self-reported symptoms. Nurs Res. 2003;52(6):370–9.CrossRefPubMedGoogle Scholar
  29. 29.
    Ward LC, Dylke E, Czerniec S, Isenring E, Kilbreath SL. Reference ranges for assessment of unilateral lymphedema in legs by bioelectrical impedance spectroscopy. Lymphat Res Biol. 2011;9(1):43–6.CrossRefPubMedGoogle Scholar
  30. 30.
    Ward LC, Dylke E, Czerniec S, Isenring E, Kilbreath SL. Confirmation of the reference impedance ratios used for assessment of breast cancer-related lymphedema by bioelectrical impedance spectroscopy. Lymphat Res Biol. 2011;9(1):47–51.CrossRefPubMedGoogle Scholar

Copyright information

© Society of Surgical Oncology 2014

Authors and Affiliations

  • Harvey N. Mayrovitz
    • 1
    Email author
  • Daniel N. Weingrad
    • 2
  • Lidice Lopez
    • 2
  1. 1.College of Medical SciencesNova Southeastern UniversityDavieUSA
  2. 2.Cancer HealthCare AssociatesAventuraUSA

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